RESUMEN
Stroke is the leading cause of long-term disability, and many stroke patients have hemiparesis. Hemiparesis induces ankle-control disturbances and equinovarus deformity, leading to difficulty in walking and an increased risk for falling. Plastic ankle-foot orthosis (PAFO) is frequently prescribed to correct ankle joint alignment and increase walking speed and stride length during ambulation. While several studies have shown that PAFO improves gait parameters, such as stride length and walking speed, in hemiplegic patients, the effect of PAFO on gait stability remains unclear. We quantitatively assessed the effect of PAFO on gait stability in 16 hemiplegic stroke patients (mean age 55.9 +/- 11.8 years; 5 female and 11 male subjects; and 11 hemorrhagic and 5 ischemic stroke) using an ink footprint record. Wearing PAFO significantly improved the stride length, step length on the unaffected and affected sides, step width, walking speed, step frequency and functional ambulation ability. The coefficient of variation (CV), as an index of stability of movement from trial to trial, provides a measure that defines motor skills for a given task. Unaffected-side step-length CV and step-width CV were significantly decreased, when using PAFO. Furthermore, the correlation was found only between unaffected-side step length and its CV. The decrease in CV indicates that PAFO improved gait stability. We concluded that in addition to providing a faster gait, PAFO improves gait stability during walking. Gait stability and gait efficiency need to be considered separately in evaluating the effects of ankle-foot orthosis on gait performance in hemiplegic patients.
Asunto(s)
Marcha , Hemiplejía/etiología , Aparatos Ortopédicos , Accidente Cerebrovascular/complicaciones , Adulto , Anciano , Tobillo/fisiopatología , Femenino , Pie/fisiopatología , Hemiplejía/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Paresia/complicaciones , Paresia/fisiopatología , Accidente Cerebrovascular/fisiopatologíaRESUMEN
OBJECTIVE: The Manual Function test (MFT) is an upper-limb function assessment measure for hemiparetic patients after stroke. This study represents the reliability and validity of the MFT. DESIGN: Ninety patients within half a year after stroke onset were hospitalized from August 2005 through November 2006. Test-retest reliability, interrater reliability, and internal consistency reliability of MFT were investigated. Validity of the MFT was evaluated with the Brunnstrom Stage, the Stroke Impairment Assessment Set, and the Barthel Index. RESULTS: The test-retest reliability coefficient and interrater reliability of the MFT were consistently above 0.95. Cronbach's alpha coefficient as internal consistency of eight items was also 0.95. With respect to the validity of the MFT, it had a correlation of >0.8 with both the Brunnstrom Stage and the Stroke Impairment Assessment Set. The correlation among task items within each category was also high. There was a higher correlation (rho = 0.647) between the MFT and Barthel Index. Among the Barthel Index items, "dressing" had the highest correlation with the MFT, which indicates that upper-limb functions and degree of independence in dressing are highly correlated. CONCLUSIONS: It was concluded that the MFT offers reliable and valid methods for assessing for upper-limb functional disorders.
Asunto(s)
Brazo/fisiopatología , Dedos/fisiopatología , Accidente Cerebrovascular/fisiopatología , Actividades Cotidianas , Adulto , Anciano , Anciano de 80 o más Años , Evaluación de la Discapacidad , Femenino , Indicadores de Salud , Humanos , Masculino , Persona de Mediana Edad , Paresia/diagnóstico , Paresia/fisiopatología , Paresia/rehabilitación , Psicometría , Recuperación de la Función , Reproducibilidad de los Resultados , Índice de Severidad de la Enfermedad , Estadística como Asunto , Accidente Cerebrovascular/diagnóstico , Rehabilitación de Accidente Cerebrovascular , Resultado del Tratamiento , Adulto JovenRESUMEN
Few studies have revealed the impact of tele-coaching on patients with intractable diseases, including intractable neurological diseases. This study aimed to analyze and describe subjective evaluations of coaches and intervention subjects on the functions of tele-coaching intervention for patients with spinocerebellar degeneration. This qualitative descriptive study was conducted between December 2005 to July 2006. Immediately prior to data collection three experienced coaches had delivered individual 10 session semi-structured tele-coaching interventions to 24 subjects. Data from the 24 logs kept by coaches and individual interviews with the three coaches and nine patients were analyzed using a content analysis technique. Although patients' subjective evaluations varied, the themes that emerged from the data analysis were generally positive: that the tele-coaching enabled patients to tell their own stories in a daily-life setting, encouraged them to experience and adopt fresh points of view, and helped them to start working towards attainable goals without giving up. Our results indicate that it is especially important to encourage patients with intractable diseases to become aware of their latent desires and goals. For patients such as those with spinocerebellar degeneration the time frame for coaching interventions might be extended when required to accommodate treatment of their changing medical and mental condition.
Asunto(s)
Degeneraciones Espinocerebelosas/rehabilitación , Telemedicina , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Motivación , Satisfacción del Paciente , Investigación Cualitativa , Autoeficacia , Degeneraciones Espinocerebelosas/psicología , Teléfono , Resultado del TratamientoRESUMEN
Stroke is the leading cause of long-term disability. Accurate assessment of motor function is important for documenting disability and the effectiveness of rehabilitative treatment. The Manual Function Test (MFT) was developed to evaluate unilateral manual performance in hemiparetic patients after stroke. This test consists of eight items, including the pegboard task, an item assessing dexterity. The total MFT score can range from 0 (severely impaired) to 32 (full function). We sought to determine normative data and explore influences of age, gender, and hand dominance. Three-hundred thirty-three healthy adult subjects between 20 and 90 years old were studied. Total MFT scores showed negative relationship to age. Compared with subjects in their 20s, those 50 or more years old had lower total MFT scores for dominant hands, as did those 40 or more years old for nondominant hands. For subjects in their 30s and 50s, total MFT scores for women were greater than for men concerning nondominant hands. No such gender difference in total MFT scores was noted for dominant hands. In the pegboard test, the number of pegs achieved for dominant hands was related to age when age was 50 or over, and when age 40 or over for nondominant hands. However, rates of decline in numbers of pegs achieved were similar between hands. In determining MFT norms, total score and items testing dexterity were influenced by age, gender, and hand dominance.
Asunto(s)
Envejecimiento/fisiología , Lateralidad Funcional/fisiología , Mano/fisiología , Destreza Motora/fisiología , Desempeño Psicomotor/fisiología , Caracteres Sexuales , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valores de ReferenciaRESUMEN
OBJECTIVE: To examine effect of coaching intervention on psychological adjustment to illness and health-related QOL (HRQOL) in patients with spinocerebellar degeneration. DESIGN: Randomized controlled trial. SUBJECTS: Twelve independently living patients with spinocerebellar degeneration aged 20-65 years old, without cognitive impairment or psychiatric disorder received coaching intervention, which was postponed in another 12 (control). INTERVENTIONS: Three physician coaches telephoned assigned patients for 15-30 minutes in each of 10 weekly coaching sessions over three months. MAIN OUTCOME MEASURES: Primary endpoints were HRQOL (SF-36) and psychological adjustment to illness (Nottingham Adjustment Scale, Japanese version; NAS-J). RESULTS: Two-way analysis of variance (group x time) showed statistically significant main effects of time for vitality (F = 5.00; P = 0.036), anxiety/depression (F = 5.15; P = 0.033), and locus of control (F = 5.58; P = 0.027), indicating improvement of scores over time in both coaching and control groups. No main effect of group or interaction was seen. However analysis of covariance with baseline scores as the covariate showed the coaching group to have better self-efficacy scores than controls at follow-up (least-square mean, experimental group, 65.1; control group, 52.7; P = 0.037). CONCLUSION: Carefully structured telephone coaching can improve self-efficacy in patients with spinocerebellar degeneration.